Women with recent pregnancy complications, such as gestational diabetes mellitus (GDM) and hypertensive disorders in pregnancy (HDP), have an increased risk of developing cardiovascular disease (CVD). Pregnancy provides a unique opportunity to identify women with these vascular risk factors earlier in life. Yet, we are missing this window of opportunity, as women are often lost to follow- up postpartum and do not received recommended care. There is a paucity of evidence on how to effectively promote and sustain CVD-preventive health behaviors in this high risk population. The overall objective of the proposed study is to identify barriers to and predictors of CVD-preventive health behaviors, including medical follow-up and healthy lifestyle behaviors, in the postpartum period in women with recent GDM and HDP. Using the PRECEDE-PROCEED model, we will use these findings to develop an interventional study to address the predisposing, enabling and reinforcing factors that influence CVD-preventive health behaviors. Results from this proposal could have broad implications for the development of practical and sustainable strategies to decrease CVD morbidity and mortality in women. The specific aims are to: 1) conduct a retrospective cohort study to describe healthcare utilization patterns and predictors of follow-up medical care in the first year postpartum in women with GDM and/or HDP; 2) conduct a prospective cohort study to determine predictors CVD-preventive behaviors in the first year postpartum in women with GDM and/or HDP; 3) design and carry-out a pilot multilevel educational-behavioral intervention to increase CVD-preventive health behaviors in women with GDM and/or HDP. The candidate is completing a clinical research fellowship in General Internal Medicine (GIM) at Johns Hopkins University School of Medicine and will take an Assistant Professor post at Johns Hopkins in July, 2009. Her primary mentor is Dr. Jeanne Clark, Associate Professor of Medicine and Epidemiology, with extensive experience in mentoring, epidemiology, and the design of clinical trials. Her co-mentor is Dr. David Levine, Professor of Medicine, principal investigator of the NHLBI training grant on behavioral aspects of CVD and an established investigator and mentor. The candidate's long term career goal is to establish an independent research program in the primary prevention of CVD in women. To accomplish this goal, her short term goals involve a career development plan to enhance her skills in longitudinal data analysis, health survey research, health behavior science, and the design and conduct of clinical trials. Results of this proposal will lead to the development of a pilot intervention in years 4 and 5 and an R01 proposal early in year 5 to investigate the effectiveness of an intervention to improve CVD-preventive health behaviors in the postpartum period in women with recent GDM and/or HDP.